Role of HbA1c as a Predictor in Healing of Diabetic Foot Ulcer (DFU) at a Tertiary Care Hospital: A Prospective Observational Study

Background: Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, often leading to amputation and substantial morbidity. Glycemic control, as measured by glycosylated hemoglobin (HbA1c), may influence wound healing outcomes in diabetic patients. Objective: To assess the healing rate of diabetic foot ulcers in patients with different HbA1c levels and evaluate associated risk factors leading to delayed wound healing. Methods: This prospective observational study was conducted at Mandya Institute of Medical Sciences over one year, involving 168 patients with type 2 diabetes mellitus and diabetic foot ulcers (Wagner grades 1 and 2). Patients were divided into three groups based on HbA1c levels: Group 1 (<7%), Group 2 (7-8%), and Group 3 (>8%). Wound healing was assessed by area reduction over 15 days using digital photography and tissue analytics software. The rate of wound healing was calculated as area reduction per day. Results: The study included 127 males (75.6%) and 41 females (24.4%) with a mean age of 56±11 years. Group 1 (n=55) showed the highest mean area reduction (10.8±3.8 cm²) and healing rate (0.72±0.26 cm²/day), followed by Group 2 (n=60) with area reduction of 10.1±3.1 cm² and healing rate of 0.67±0.2 cm²/day, and Group 3 (n=53) with the lowest area reduction (6.2±3.7 cm²) and healing rate (0.4±0.24 cm²/day) (p<0.001). Strong negative correlations were observed between HbA1c levels and both area reduction (r=-0.566, p<0.001) and healing rate (r=-0.578, p<0.001). Conclusion: Higher HbA1c levels were significantly associated with slower diabetic foot ulcer healing. HbA1c can serve as a reliable predictor of wound healing outcomes in diabetic patients, emphasizing the importance of optimal glycemic control in DFU management.